Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan; Department of Neurosurgery, Teikyo University Hospital, Tokyo, Japan.
World Neurosurg. 2022 Nov;167:e1448-e1454. doi: 10.1016/j.wneu.2022.09.069. Epub 2022 Sep 18.
In the multimodality treatment of complex brain arteriovenous malformations (AVMs), the role of endovascular embolization is not fully elucidated. To assess the risk of embolization, we retrospectively evaluated the outcomes of endovascular treatment for AVM, focusing on the embolization-related complications.
The present study included patients with brain AVM who underwent embolization at our hospital between April 2011 and May 2021. Risk factors for peri- and postoperative complications were analyzed.
During the study period, 36 AVMs were treated during 58 embolization sessions. The goal of the embolization was preoperative in 24 (67%), pre-radiosurgical in 9 (25%), and palliative in 3 (8%) cases. The overall complication rate was 43% (25 of 58) per session and 36% (13 of 36) per patient. Ischemic and hemorrhagic complications were observed in 14 (24%) and 14 (24%) cases, respectively. n-Butyl cyanoacrylate (n-BCA) embolization was detected as the significant risk for postoperative hemorrhage in the univariate (79% vs. 36%, P = 0.012; Fisher exact test) and the multivariable analysis (odds ratio 4.90, 95% confidence interval 1.08-22.2, P = 0.039). The number of embolized feeder in a single session also tended to be higher in a hemorrhagic complication group (median 3.5 vs. 2.0, P = 0.11; Mann-Whitney U-test).
The risk of embolization in multimodality treatment for complex brain AVM was substantial. n-BCA embolization may carry a higher risk of postoperative hemorrhage. An accumulation of cases is awaited to investigate the effectiveness of minimal target embolization in the future.
在复杂脑动静脉畸形（AVM）的多模态治疗中，血管内栓塞的作用尚未完全阐明。为了评估栓塞风险，我们回顾性评估了血管内治疗 AVM 的结果，重点关注与栓塞相关的并发症。
本研究纳入了 2011 年 4 月至 2021 年 5 月在我院接受栓塞治疗的脑 AVM 患者。分析了围手术期并发症的危险因素。
研究期间，58 次栓塞治疗了 36 个 AVM。栓塞的目的为术前 24 例（67%）、术前放射外科治疗前 9 例（25%）和姑息性 3 例（8%）。每次栓塞的总体并发症发生率为 43%（58 次中的 25 次），每位患者的发生率为 36%（36 例中的 13 例）。缺血性和出血性并发症分别在 14 例（24%）和 14 例（24%）中观察到。单变量分析（79% vs. 36%，P=0.012；Fisher 确切检验）和多变量分析（优势比 4.90，95%置信区间 1.08-22.2，P=0.039）均显示 n-丁基氰基丙烯酸酯（n-BCA）栓塞是术后出血的显著危险因素。单次栓塞中栓塞的供血动脉数量在出血性并发症组中也较高（中位数 3.5 比 2.0，P=0.11；Mann-Whitney U 检验）。
在复杂脑 AVM 的多模态治疗中，栓塞的风险相当大。n-BCA 栓塞可能会增加术后出血的风险。需要积累更多的病例来研究未来最小目标栓塞的有效性。
